"That's like an act of suicide" patients' attitudes toward deactivation of implantable defibrillators

Nathan E. Goldstein*, Davendra Mehta, Saima Siddiqui, Ezra Teitelbaum, Jessica Zeidman, Magdelena Singson, Elena Pe, Elizabeth H. Bradley, R. Sean Morrison

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

139 Scopus citations

Abstract

OBJECTIVE: To understand potential patient barriers to discussions about implantable cardioverter defibrillator (ICD) deactivation in patients with advanced illness. DESIGN: Qualitative focus groups. PARTICIPANTS: Fifteen community-dwelling, ambulatory patients with ICDs assigned to focus groups based on duration of time since implantation and whether they had ever received a shock from their device. APPROACH: A physician and a social worker used a predetermined discussion guide to moderate the groups, and each session was audiotaped and subsequently transcribed. Transcripts were analyzed using the method of constant comparison. RESULTS: No participant had ever discussed deactivation with their physician nor knew that deactivation was an option. Patients expressed a great deal of anxiety about receiving shocks from their device. Participants discussed why they needed the device and expressed desire for more information about the device; however, they would not engage in conversations about deactivating the ICD. One patient described deactivation "like an act of suicide" and all patients believed that the device was exclusively beneficial. Patients also expressed a desire to have their physician make the decision about deactivation. CONCLUSIONS: None of the patients in our study knew that they might need to deactivate their ICD as their health worsens. These community-dwelling outpatients were not willing to discuss the issue of ICD deactivation and their attitudes about deactivation might impede patients from engaging in these conversations. These findings are in contrast to findings in other advance care planning research and may be related to the unique nature of the ICD.

Original languageEnglish (US)
Pages (from-to)7-12
Number of pages6
JournalJournal of General Internal Medicine
Volume23
Issue number1 SUPPL.
DOIs
StatePublished - Jan 1 2008

Keywords

  • Advanced technology
  • Communication
  • Implantable cardioverter defibrillator
  • Palliative care
  • Patient-physician relationship

ASJC Scopus subject areas

  • Internal Medicine

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